Facility Evaluation Report

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA explained the reason for the visit. LPA and staff toured the facility. Facility is licensed for 6 non-ambulatory residents and a hospice waiver for 2. Facility is a single story home with 4 resident rooms, 3 bathrooms, 1 staff room, living room, family room, eat in kitchen and a 4 car garage that is used for storage. LPA observed the See Something, Say Something poster (PUB 475) posted in the main entry of the facility. LPA toured the kitchen. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed medications are kept locked in a kitchen cabinet. Knives are kept locked in a kitchen drawer. Smoke detectors and the carbon monoxide detector tested operational. LPA observed there are no night lights in the hallways. LPA observed all resident rooms had the required furnishings and bed linens. LPA observed there are no missing window screens. All 3 bathrooms are clean and operational. Hot water measured 103.2 degrees Fahrenheit in all bathrooms. The garage is kept locked and used for storage. LPA observed the room in the garage is now used to store supplies and tools. LPA observed emergency food and water and furniture stored in the garage. LPA and staff toured the backyard. LPA observed the facility has a pool that is empty. The pool is fenced and the pool gate is locked. The pool is inaccessible to residents. LPA observed the backyard exit gate on the South side of the house is operational. The exit gate on the North side is operational. LPA observed all the ladders and building materials that were present at the facility during the last annual inspection have been removed. LPA reviewed 2 staff files. Staff had CPR training and the required 20 hours of annual training. LPA reviewed 5 resident files. 5 out of 5 residents did not have a current appraisal/needs and care plan. No other discrepancies observed. LPA observed there is no dedicated internet device for resident use. A review of facility records shows there is no verification of a recent emergency drill.